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HomeMy WebLinkAboutBP25-072PERMIT # �U/oO 74 DATE: / %AS ®(P: 'y / 7 SECTION BLOCK LOT 5 TYPE OF WORK Oe7Vel�Sjol? M JOB LOCATION 3 Cf-©SS 4oa OWNER EVa A)Q l q C Za3 - j w r6 CONTRACTOR /Jq s000eCo�,o -�fph� k4mpT. COST CO #�l TCO # FEE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT G7 ALARM AS BUILT C� FINAL DATE INSP c31 0 OTHER APPROVALS �yE BRnv� ,cc,;0- 1.,. 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 June 26,2025 Eva Wallace 3 Crossway Rye Brook,New York 10573 Re: 3 Crossway,Rye Brook,New York 10573 Parcel ID#: 135.26-1-55 Building Permit#25-072 issued on 4/17/2025 to Covert from Septic to Village Sewer This certifies that the conversion from septic to Village sewer,under the above captioned permit has been satisfactorily completed. Sincerely, "I Steven E. Fews Building&Fire Inspector /to REcE �YE CYEBROOK,�t BUILENT For office u e onl : -7 PERMIT# JUN 2 5 2025 VILK ISSUED: 938 KING STREYORK 10573 DATE:LpVILLAGE OF RYE BROOK FEE; �a� PAIDA BUILDING DEPARTMENTv 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 iffiitttkfttt4#tk#kk44ii44##ii4ti}ttiiiiiift4#t#######44tt#ktk#}}it}tftkf4#tt#####4i#i###i########}tff#k#f#t4###i#ki44ttiii#} Address: 3 OR() SSW 1C*A Occupancy/Use: //� Parcel ID#: /36 SS Zone: —! J Owner: IE�v CI ill O- Cl C(2— / Address: � C-QOSSW AA P.E./R.A. or Contractor: L_QOCC ,�,17dW_0,4VL Address: a'6 Sef`-�_--c5n �- \Ne!F- 340 '1'-61'11 N� Person in responsible charge:._hh 4 7 G 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: IENQ N{011 iUco— being duly sworn,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) in g- e $r o o IL ,in the County of W e Q;-�GV 1 e S�� 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: 0 0 / c , for the construction or alteration of: C0f e(gA� � Y S cy ec*- C_ *O VI[ �ay'e JeX)0_� 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§250-1 O.A.of the Code of the Village of Rye Brook. Sworn to before me this oZT Sworn to before me this day of 20 a c day of 20 �Sioature of Prope er Signature of Applicant 4F'q WM.I U611) Print Namez rty Ow Print Name of Applicant 4 �'� Notary Public STATE OF LAURA MOREA COUNTY 6/1/2024 Notary Public SUBSCRIBED AN RN TO BEFORE ME Connecticut THIS 3 _DA,YO = L Commission Expires Setp 30, I BY yr CA� NOTA PUBLIC � 6 BRX O tim BUILDING DEPARTMENT ❑B ILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCFMI:NT OFFICER 938 King Street • Rye Brook, NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :Z—CAJQ A5._W_Pk 4 - --- DATE:—as `aw'r PERMIT# _ J ._q2 7 Z ISSUED:. :/2-,49ic-r: o,�42- BLOCK: LOT: LOCATION: OCCUPANCY:_` ❑ Violation Noted THE WORK IS... RS PASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE. ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P.Gas y t l.l..a_�D st?GJ cV / a-i - ❑ FUEL TANK ❑ FIRE.SPRINKLER Rid I+'1 p, ❑ FINAL PLUMBING T ❑ CROSS CONNECTION -- ,2-TINAL ❑ OTHER :N A''- f- . Y: i _.. y .i• T 4#. '�: ,•�,�. it l to • '�' '� •£..+ .YAK � • � {�j e•. � �1��1' �.� (, r�Mr��r n .+ J �c i r rt. QyE 4RC�� BUILDING DEPARTMENT ❑/BUILDING INSPECTOR E,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 :_ cwss Wao{.l DATE: 6-/S' ZOZS" PERMIT# g,P ZS `V 7 Z ISSUED: SECT: BLOCK:LOT: -Sr LOCATION: R er, re-y T a,-,.W• 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 IAC.,/ [ �I.u, O se,41 (, �P•N ❑ L.P. GAS �P m 0 VoJc. G1w �Gh ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ) I ( ( c OTHER C. 01 T' / e- /c�� a e�t r W ) dT k;& en CaM M P c� (oS foS (�. 4 r+7 a r L • Cc��►'> • ,�y. .. /. - - .,�-•��/ 'jar, I� '�; 1•�j' , r � 1 r l c Ar r 1 ,w 'fit- , •x i+• r _� T., t ,♦ f�J � l e r I =�r I Ii low Owl w.r M QyE BRnuk l7 -c 1982•� BUILDING DEPARTMENT ❑BUI ING INSPECTOR ZSSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMEN'r OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - `ADDRESS : { DATE:-6" IZ �dG%J PERMIT# U\ 1�� V� 1 ISSUED: / -ZJSECT: /W- ?4! BLOCK:_LOT: LOCATION: rl" OCCUPANCY' ❑ VIOLATION NOTED THE WORK IS... ' ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION .Er UNDERGROUND PLUMBING NOTES ON INSPECTION: ,8' ROUGI-I PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS 1!� 4t .Q •SQ�.V ❑ L.P. GAS nn ❑ FUEL TANK ( 4Ap ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL Oi�. e JET w (',ti .Z.I�., M •cs jL ❑ OTHER Village of Rye Brook Public Works and Engineering Department ID 938 KING STREET•RYE BROOK,NY 10573 1982 '� (914)939-0753 FAx(914)939-0242 INSPECTION REPORT Address: Date:Name: Location: �� � f Permit#: Phone: Email: Work being Inspected: ;1 / / � T Work Inspected is: Rejected Re-Inspection Required Violation Noted Code Section Code Section: Action Taken Code Section: Action Taken 118 Erosion Sediment Pass Fail Violation 210 Storm Water Pass Fail Violation 135 Refuse Pass Fail Violation 215 Street Sidewalk Pass Fail Violation 213 Steep Slopes Pass Fail Violation 235 Trees Pass Fail Violation 216 Illicit Discharge Pass Fail Violation 245 Wetlands Pass Fail Violation Other: L�(,v f� �Ss) Fail Violation Notes: A&I Diagram: Signature %�� �yE BRC��, O� 2m 1982 BUILDING DEPARTMENT �❑BBUILDING INSPECTOR CJ 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 : DATE: 20 Z O Z.S PERMIT# O� ! ISSUED: I7 ~ SECT: 2(a BLOCK: LOT:S� LOCATION: S! k-t + OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ►d ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION El UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS `V p L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION f ❑ FINAL 1 �� SC g c) 1 P • ❑ OTHER rr :'!pfR� It • .. � A�.1��k ra ,r'141 jar � � Iry .64 ,ftN Ilk .*.` ', `.L.� •vim �' :��."+_t�. ��{' �r �t "fir' '��1..�• � r i��i] ��/�' -1 f /� ..� 11"1 �� �+� •�...s �J.�p'�` r - - �� h�+ `'`r C% Syufl~I t#�1:, .��� 1�.� c•}•- '.ta��G:#�y�• +1'ii` It+ � �:�. � ,1• l}r � vXf�' ���� ` huh• y�•`4`7 ` ~ ` - � .� (..�`,� +,.�• n� '�..i:�St- ,���.t.'O.j��S~����r'' �.�,A ��'- '_•' � j '1.t 1+1�♦ ,... � 1f�;u�_� • � �ti �� •'� ,_. ` .'�1.. tit apr,�• �.,, !' �;� 4' :� .:� ;�'� •'.. r��• t!hr 'yr' ' � •••;,��>�ey � M""r-•'�„'a.r Y, `���� ,�.� � + •_. ) , y rQr 1 art ' • Ff ,j` L. 1, �y QyE BRC��. BUILDING DEPARTMENT ❑PUILDING 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 : w n6 DATE: ..7' L 025� PERMIT#�1 j- J7�1 ISSUED: /y-h SECT: -5--Ao BLOCK: LOT: LOCATION: �, + t 40 tA Cp, `) C, OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 2 ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION _®''-bNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION n�� ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING -� ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Zn< !V a ' h N ■ x OI N N ^N r- IMCI y ICI N rY� p�, �' �� Q 1�1 ■ o x h+a Gn F+� 1•'�I cr Ln Lin _ en z g c p O I H N ■ � O � W �; Q y o o � �'� �1 ■ O O ^�71 a ti Ow o �Cd Gl s ■ W 0-4 � N CO3 0 ,5 Fii z o�W 0�0 C1� Q Pay en �C z V z r- 4 c7 a o a w U W 00 cn W � CD ■ � Cti U W a � aC -� o 'S 'd � z oa cn21 O o a � (1:4 Cv7 � A z O .. A W z o5 g o a s Bum MENT VIJETO F RIT OK93$KING RY> BR ,NY IQ573 MAR 2 0 2025 ov VILLAGE OF RYE BROOK FOR OFFICE USE ONLY: c —7 Approval Dats �, �OJ Permit# 7 } ( Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: # : Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: / 7 Application Fee: I Permit Fees: l EXTERIOR BUILDING PERMIT APPLICATION Application dated: 6 1 2 is hereby made to the Building lnspector 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: 3 CRc+SS%r,aA-�j 2. Parcel ID#: 1%5.2b 1 - 55 Zone: R- I5 3. Proposed Improvement(Describe in detail): PRoPOSUD CQr4YFRS10 N i=Roin, 51—PTIC_ TO —1_0_ (r`I Stews 4. Property Owner: GAmEftrJ w A tLA LE Address: CIZO Phone# 2,05- 11513- 12-12 Cell# e-mail C arrwner 65b5 Q 41nai 1.Coro% List All Other Properties Owned in Rye Brook: Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: ANr,,y_c"Eut-+,[ p.F Address: q DO N SIt_t_ flit Sornse s ,N! %05139 Phone# q 14-26a -4 2.'S Sell# e-mail 2 4-0_una Q 2Cex%yneeroni p�IC. General Contractor: k✓?Q Q t�SC e,/�O —J1 A"7 I,�.L/t/►Q r•Conn Address: " �f Sc�fr S�. �� 7�QIr�SOn /y r /o/ _ .. Phone# 917-90b- a3/0 Cell# e-mail (1) 6/1/2024 5. Occupancy;(1-Fam.,2-Fain.,Commercial.,etc...)Pre-construction: l-f&^ Post-construction: 1 - 6. Area of lot: Square feet: 15 1 Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: 8. if building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: I I fl: 2nd fl: 3r'fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: 11 fl: 2nd fl: 3rd fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13, N.Y. State Construction Classification: N.Y. State Use Classification: 14. Number of stories: Overall Height: Median Height: 15. Basement to be full,or partial: finished or unfinished: 16. What material is the exterior finish: 17. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 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 existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type 1 Hood,etc...) Yes: No: ✓ (if yes,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: ✓ 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 survev) 24. Is the lot located within 100 ft. of a Wetland as per§245 of Village Code? Yes: No: (j'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: ✓ (f 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:--X/— (f 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: (if yes,a Home Occupation Permit Application is required) 28. List all zoning variances granted or denied for the subject property: N I A 29. What is the total estimated cost of construction: S CD-I, Note:The estimated cost shall include all site improvements, labor,material,scaffolding,f6ed 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 C/O. 30. Estimated date of completion: M o (2) 6/1/2024 BUILD �_&PA>rRTMENT VI E OF RYE OOK 938 KING W ET RYE BR NY 10573 i.4} tiO4G�� r y l" ov 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: 3, Eva \NCA I t a CO— ,residing at, ?j C coeeu"xy � b_(O®k+ (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; 3 Gr 0 S S wN , lye 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. (. nature of Propem Ovine -E:v Ix W a< I � CA c0_ (Print Name of Property Owner(s)) Sworn to before me this day of 'S�Sn fit\ , 20 V\L�L' (Notary Public) SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County (6) Commission Explres Jentlary 29,201_� 6/1/2024 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 OF NEW YORK,COUNTY OF WESTCHESTER ) as: Cva W C1 1`a CQ: ,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 Luna for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc-) That all statements contained herein are true to the best of his/her knowledge and belief, and that any work performed, or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention& Building Code,the Code of the Village of Rye Brook and all other applicable laws, ordinances and regulations. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this 'Sworn to before me this day of , 20 day of , 20 4ignature of Pr wner Signature of Applicant l;�vat W 'Pt Ilacs_ Print Name of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLQ Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20� (8) G/1/2024 i a, t� t� t i O N Ln W s � N N N N a i W \ � r7' �w� O a' Ln Ln C9ul W a_ W Cs. 00 ■ 1-1 Or 4 W `n Ln T-4 bt ,c U Cs a z W cv � - o v x en *-' c� _ v U � • C ^W \ x U — �p a Q W Ln •' � � c �"r � w V � 1 � R„r eq a 06CA Ln O ` q H x w 00 z W Z Nu W�rl ON rr hh�� M G1 0000 00 h+y d U xi n 0-4 ■ 0-4 w O � x o Wa z o � M q a z W O a oG COF BUIIED NU D �/VIU1)OK938 ICllyOK,NY 10573 MAY - 6 20258 n VILLAGE OF RYE BROOK ELECTRICAL PERMIT APPLICATION BUILDING DEPARTMENT Westchester County Master Electricians License Required �^l FOR OFFICE USE ONLY BP#: �'\-J 73- EP#: d`�— �CJ Approval Date: MAY 0 7 2 Permit Fee: $ O Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 6- 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. I.Address: SBL: Z35;c)42 S- Zone: X=_l 2.Property Owner: Address: Phone#: Cell#: �755�, email: 3.Master Electrician/Licensed Installer: Address: Lic.#:__2�0_ 1 Phone#: 1t(I' '90'l?W/Cell#: f email: C Ll ci,rwl e ei'r �Jz l 0 �1,Ini.7-&n Company Name: Ad s: 7O UeSf Sf. / yf- all f' rP.r'So'►�/ J��a 4.Proposed Electrical Work/Fixture Count: I Y- -I*Y r,eW CA yr,r,; )- !!RQ�f {5 � m r Ptn / p CA �A`y d� 49larrh JL4, C and-4A Ida" [Aeije ,c/m,� f cdwx T 1 o�-_ 5.31 Party Electrical Inspection Agency: Ro te,r 1+0r-le S STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: "M r ""C ly-t( 2t1-1WVt-0 L ,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 /YI L Sim 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 befAr me this Sworn to before me this day of M a`_�__,20 a- day of ,20 Signature of Pro erty Owner Signature of Applicant n &ame of Property O er P ' Name of Ap lican ME Wr 'tomNit, a 6160063 GREGORr �tA rc Qualified in Westchester county Netary Public,State of New York 6/1/2024 0 Commission Expires JanUary No.OIRI6441398 Qualified In Westchester County COtprrtlssion Exnirnc 5 Buckout Road BETTER HOMES to West Harrison, 104 All�� Phone:914-90906-044443 ELECTRICAL INSPECTION SERVICES INC. " Email:betterhomes252@gmail.com NAME: DATE: ELECT.PERMIT NO. CITYNILLAGE ZIPCODE BLDG PERMIT NO. 17 3 07� ADDRESS: BUILDING DEPT Vl,//O -)f rzye PHONE# SECTION BLOCK LOT UTILITY rot/ EMAIL ADDRESS: + Residential ❑ Commercial ❑ t�ari��° Itor��,c OWNER'S NAME AND ADDRESS /'G VIAe-I,on Cc" 0 RECEWE 3 r n ss wA-y , 12 YC 9✓-vk Al Y, 10s7 , MAY - 6 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT WORK LOCATION: ❑Outside ❑Basement ❑Garage ❑Attic ❑Porch Floor: ❑1 st floor ❑2nd floor ❑3rd floor ❑4th floor ❑Other floor ❑Reinspection ❑Renovation ❑Generator ❑New home ❑Other Comments: i If t _. 1-4 (0►� 1 �S� i l (o► � ,' �- U� �y,�ow�� j Yo� CD r'N'&) box �e�✓i°t 1P� , SERVICE AMPS CASE NO. SERVICE ENTERS BUILDING: Overhead ❑ Underground ❑ CON EDISON COMPANY NAME: DATE OF APPLICATION: LICENSE#WHEN APPLICABLE: STREET ADDRESS: CITY: STATE: ZIPCODE: r F TELEPHONE: CELL PHONE: EMAIL: SIGNATURE OF APPLICANT: X The application is intended to cover the above listed items to be inspected.If at any time of inspection additional items have been installed,we are authorized to make the inspection and adjust the fee for the additional items inspected as provided by the applicant.The applicant declares that there are no open applications for the above with any other inspection company.Application only good one year after filing date. D J U N 2 3 2025 BY THIS CERTIFICATE OF COMPLIAN ;ALLAGE OF RYE BROOK Better Homes Electrical Inspection Serv1�66gljh IEPARrMENT 5 Buckout Road, West Harrison, NY 10604 914-906-0443 CERTIFIES THAT Upon the application of: Upon premises owned by: Chamo Electric Eva Wallace 70 West Street 3 Crossway Harrison, NY 10528 Ryebrook, NY 10573 Certificate Number: 4289 Certificate Date: 6/19/25 Located at: 3 Crossway Occupancy Type: Residential Ryebrook, NY 10573 Permit Number: EP- 25-120 Section: 135.26 Building Permit Number: BP-25-072 Block: 1 Lot: 55 A visual inspection of the electrical system at this premise described above, wherein the premises electrical system consisting of electrical devices and wiring, described herein. All inspections are in accordance with the National Electrical Code and the details of the installation, as set forth below, was found to be in compliance therewith on the date of the inspection. Name Quantity Rating Circut Type Wiring for an outdoor sewer pump, 1 240v 25a Sewer pump & control panel and alarm control panel. 1 120v 15a Alarm for overflow 111 so, This certificate may not be altered in any way. .`�;�s�>k,��•,�o; ` l �`�� _ SEAL This certificate is valid for work performed = 2022 Cb ZF before the date of inspection only. •2 l�'•-r� Licensed Inspector P Y. y ••�vo•. 7 III11\0�\\ • tl f vi t� W a cneN N p C rr .I z 60 uz � t� cNx w O z � v � > ° V ' t f � °O T-4 • � � ^ � � W U N O � � n � f.y r N O'G f OZmo x z ►.� ' O � n W of .-: a o � F„ S ►"'" : a o a Va V x x a _ GQ L' .� CA (�. 2 vi • i t t t sl . • t t i t t . s t tl t I t t s s * yEL3Rnv � FmAYIE �[ j I BUIL MENT 2025 VIL E OF RYE OK 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT n . ov PLUMBING PERMITT APPLICATION FOR OFFICE USE ONLY BP#: PP#: Approval Date: .S"/S — Z OZ„- Permit Fee: $ � � 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, J-1 3--c)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 Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: G r-_0_ .l1") 0, � SBL: /3 S �' Zone: 2.Proposed Work: t o C To.— 00 r '7- t','t. r^ Lit G 3.Property Owner: A10 l (Q,. Address: J Phone#: �2(] 4 Cell#: email: 4.Master Plumber: Ajr" RV (1.q Address: C2 J r— An-,-oupi Lic.#:'LA Phone#: Cell#: YW email: ✓��l✓10!?? ��� ',�l rtJll f (x�M, Company Name: M/''.' f Address: 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 31 Floor 41 Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: w c7 4r/ `/mil C, D,� 6,4,_/,l 0� (Notarized Signatures Required Next 2 Pages) -1- 6/1/2024 D ECE]WE BUILDING DEPARTMENT RF-1 VILL OF RYEBROOKAY 3 2025 938 KING SmE'r RvF BR(X)K, NY 10573 VILLAGE OF RYE BROOK (914)Eril.gov 668 BUILDING DEPARTMENT wH H e - -- 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: j, Ev a WG I( Gt co— residing at, ?j ccos6 NAp j � bi k, M i Print name i l Address cchcre%ou Itsei 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; 3 Gros 5"Cq , 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. _nature ul PropertN t hale ova WaI Ia C-a— t l rnu Name,,t Prnpert% (liNcneri,u Sworn to before me this g t day of 20 7 otan Public) SHARI MEULLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County (f,) Commission Expires January 29.202 e/I noia STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this d of Q X,20 day of ,20as Signature o yopertyer tgnature of Applicant Print NaMF me Property ner Print Name of Applicant S-6 No Pt#t�l#ll�l MEULLO NoLLO of ra y Public,State of New York Notary Pub ic,State of New York No.01ME6160063 No.01ME6160063 Qualified In Westchester County-? Qualified In Westchester County Commission Expires January 29,20 %co Commission Ex'Ires lantlary 29,20 Z� This application must be proted 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- 6/1/2024 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 OF NEW YORK,COUNTY OF WESTCHESTER ) as: EVrA "0 1 I Cl C-e-- ,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 %%hich this application pertains, or that (s)he is the Lut�c� for the legal owner and is duly authorized to make and file this application. (indicate architect.contractur,agent.attonx%,etc 1 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 the this Sworn to before me this day of \\ 20� day of . 20 ignature of P caner Signature of Applicant I✓v at. W of I l g CJ2� Print Name of Property Owner Print Natne of Applicant < \� Notary Public Notan Public SHARI MEULLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires Jenuafy 29,201�1 (R► 6.!I 1'2024 p .Building Permit Check List&Zoning Ag*ssiss ` [, Address: C `�Jl?- SBL• t J7S Zone.A-`S Use: Co t Type: Other. Submittal Date: Revisions Submittal Dates: Applicant: C'l C P, Nature of Work C Reviews:ZBA APR 6 2025 P& BOT: Other. NEED..-OK Q (� ( ) FEES:Filing. BP: t 3 C/O: Flood Plane: Legalization: ( ) (4.-APP: Dated: Notarized. SBL: Truss I.D. Cross Connection: H.O.A.: (t ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated Current: Archival• Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed Copies: Electronic Other. (� ( ) License: Workers Comp: Liability: Comp.Waiver. Other. CODE 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other, ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H W.I.C.:_Battery:_Other. PLUMBING:Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. O O 2020 NY State ECCC: N/A: Other. ( ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approvaL• notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• notes: APPROVED ED REQUIRED EXISTING PROPOSED NOTES Date% APR 1. 6-2025 Area: Circle: Fronts e Front: From Sides: Rear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tot : Fc I : PadjinW. Height/Stories: notes: D ECENE E Invoice Vogler Brothers Inc. SUN 2 4 2025 39 North Street Date Invoice# Katonah, New York 10536 VILLAGE OF RYE BROOK 6/16/2025 119458 BUILDING DEPARTMENT (914) 232-5535 Bill To Bills are due upon receipt. A finance Cameron Wallace 3 Crossway charge of 1 1/2% per month will be Rye Brook, NY 10573 charged on all past due accounts. We accept Visa, Master Card, Discover & American Express with a .3% charge PO No. Terms 203-788-1212 Due on receipt Item Quantity Description Rate Amount Septic Cleaned 750 gallon concrete septic tank for 550.00 550.00T contractor to cave in and hooked to sewer Sales Tax 8.375% 46.06 Total $596.06 Payments/Credits $0.00 Balance Due $596.06 Laura Petersen From: Laura Petersen Sent: Wednesday, April 16, 2025 4:09 PM To: CAMMER6565@GMAIL.COM Cc: Andy Cheung Subject: 3 Crossway- Exterior Building Permit Application 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. 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. Contractor must call UDig NY and get a ticket number. Thank you Laura Laura(Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, NY 10573 (914)939-0668 1 Laura Petersen From: Luna Landscape Corp <office@ lunalandscapecorp.com> Sent: Wednesday, April 16, 2025 4:59 PM To: Andy Cheung; Laura Petersen; Cameron Wallace Cc: Luna Landscape Subject: Re: Fw: 3 Crossway - Exterior Building Permit Application Attachments: Westchester Home Improvement License (1).pdf; CERT The Village of Rye Brook.PDF Hi Laura, Attached please find the requested information. 1. Luna Landscape Corp. - John DiLuna 914-906-2310 2. Copy of general contractor's valid Westchester County Home Improvement License. - Attached 3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) - Attached 4. General contractor's valid workers compensation on a NY State Board fo rm (C105-2 or U26.3) -Attached 5. Contractor must call UDig NY and get a ticket number. 04095-002478 On Wed, Apr 16, 2025 at 4:13 PM Andy Cheung<acheun acen ineeringpllc.com>wrote: Hi John, Please forward the information below to the Town. I pulled a SAFE DIG ticket last month. I will forward that number to you. Thanks. Andy Cheung, P.E. AC Engineering, PLLC (914)260-4239 acengineeringpllc.com From: Laura Petersen<LPetersen@ryebrooknv.gov> Sent:Wednesday,April 16, 2025 4:09 PM To: CAMMER6565@GMAIL.COM <CAMMER6565@GMAIL.COM> Cc:Andy Cheung<acheung@acengineeringpllc.com> Subject:3 Crossway- Exterior Building Permit Application 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: i '�a�� w��`M�Ls yrn�ty� � r� �� r ��y '' .1���.s.- 1'•; .� J..,� {tikr�l.p(e t- a. I f ( A yr� ^... } e y � rf`- � _�. D :� x. w.� tni'' 1 1`a 7'y "+`t^°QeY- •'^`�t� ,., (,,/1+♦odlf ►0404 u "!l//41.1,. ., ,Iri 1 �+i ,,c40�i',= � l�il+c`f, ; ++�0•`,:. r " ����)Y •.flf{�ldf.`•`rs -,s y�drf es w-h1�411:' :F ;-*g?::�t1�61V .r•�. �?'Faftl If1:- . lljl�dlf ..�. �.rll�fll- (�) !/ 000 4-4 air Y Lu 0 T�/1 E / L O LLI try y „'a `^ o c fition / 4t LU U Y 1 �/� O Y •7 + {f AN ,� i•� � tom, _ �u} /a� CO Lij 7-0 1 N• h ! s¢ti ) s ! 1 4 f 1, !1 .'� 4 1 If1�1! Ql, Ilfjl . 1 1!t ,l4111 •. ,! 1,h , 1/ ,�� �� ��y� ��•. . � _?4- .8:ht •Sa N /�r� t+t�•- / ?�� vim' ? . i.f. A ® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/16/2025 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: Aimee Nuara Quinton Insurance PHONE , (800)454-1970 FAX NI I: (585)388-9531 2700 Elmwood Ave E-MAIL ADDRESS: service@quintoninsurance.com INSURERS AFFORDING COVERAGE NAIC N Rochester NY 14618 INSURER A: ERIE INSURANCE CO 26263 INSURED INSURERB: ERIE INS CO OF NY 16233 Luna Landscape Corp and JRD Building Services LLC INSURERC: SHELTERPOINT 81434 28 JEFFERSON ST INSURER D: INSURER E WEST HARRISON NY 10604-2045 1 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 ADDLTYPE OF INSURANCE INgn SUER POLICY NUMBER MWDD//YYYY MWDO POLICY EFF POLICY EXP TR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEU-- CLAIMS-MADE Fx_1 OCCUR PREMISES(Ea occurrence) $ 1,000,000 X Primery 8r Non-Contributory MED EXP(Any one person) s 5,000 A X Contractual Liability Q61-0091595 04/16/2025 04/16/2026 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 POLICY�JECT ❑LOC PRODUCTS-COMP/OP AGG s 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COEa accidents MBINED INGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED Q04-6540064 04/15/2025 04/15/2026 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS Ix HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accdent $ X UMBRELLA LIAe X OCCUR EACH OCCURRENCE E 5,000,000 A EXCESS LIAB CLAIMS-MADE Q28-6670049 04/16/2025 04/16/2026 AGGREGATE $ 5,000,000 DED X RETENTIONS 10,000 $ WORKERS COMPENSATION X I STER ATUTE ERH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? FN NIA Q88-6600380 04/16/2025 04/16/2026 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE E 1,000,000_ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 SHORT TERM DISABILITY C PAID FAMILY LEAVE D152358 09/20/2024 i 09/20/2025 STATUTORY LIMITS DESCRIPTION OF OPERATIONS/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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. The Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook,NY 10573 ��� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE In.Legal Name&Address of Insured(Use street address only) 1b.Business Telephone Number of Insured Luna Landscape Corp and JRD Building Services LLC 28 JEFFERSON ST 1c.NYS Unemployment Insurance Employer WEST HARRISON NY 10604-2045 Registration Number of Insured Work Location of Insured(Only required if coverage is specifically Id.Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up or Social Security Number Policy) 58-2492219 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Erie Insurance Company 3b.Policy Number of entity listed in box"In" The Village of Rye Brook Q88-6600380 938 King Street Rye Brook,NY 10573 3c. Policy effective period 04/16/2025 to 04/16/2026 3d. The Proprietor,Partners or Executive Officers are x❑ included. (Only check boa tf all partners/oMcers Included) all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box "T' insures the business referenced above in box "la" 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'com pensation 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"T'. The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insuredfrom the coverage indicated on this Certificate. (These notices maybe 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. Please Note: Upon the 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: MARC CIPRIANI /�� (Print name of authorized representative or licensed agent of insurance carrier) Approved by: /�/kk1_1 ev;u� 04/16/2025 (Signature) (Date) Title: SVP—COMMERCIAL LINES Telephone Number of authorized representative or licensed agent of insurance carrier: (800)458-0811 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(9-07) www.wcb.state.ny.us Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Wednesday, April 9, 2025 3:33 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 04/09/2025 15:29 To: VIL RYE BROOK PRIMARY Transmitted: 04/09/2025 15:32 00007 Ticket: 04095-002-478-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 3 To: Name: CROSSWAY Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: LEFT SIDE OF HOUSE, FRONT YARD AND EDGE OF ROAD NearSt: Means of Excavation: MINI Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: NEW SEWER LINE Estimated Work Complete Date: 04/14/2025 Depth of excavation: 4 FEET Site dimensions: Length 80 FEET Width 2 FEET Start Date and Time: 04/14/2025 07:00 Must Start By: 04/28/2025 ------------------------------------------------------------------------------ Contact Name: JOHN DILUNA Company: LUNA LANDSCAPE Addrl: 28 JEFFERSON ST Addr2: City: WEST HARRISON State: NY Zip: 10604 Phone: 914-428-3317 Fax: Email: lunalandcorp@gmail.com Field Contact: JOHN DILUNA Alt Phone: 914-428-3317 Email: lunalandcorp@gmail.com Working for: WALLACE ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CON-ED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i III III File: D:\OneDrive - acengineeringpllc.com\AC Engineering\PROJECTS\3 Crossway-SEWER\CAD\3CW.dwg Layout: Sheet 1-Existing Site Plan User: Andy Cheung Apr 07, 2025 - 4:34pm U A r-;;DD0m0-0rn D m r O z- m 0- :EQ nG)m(;nC> c„CMcZ�ODz_ n m z m m z Z Omm�QQZZ Z�Nz7o-nmr- v(n0DDDL�Ln o0ZZzr"y D NmD>CZinmO �m-DG< C) O T ®;0 Z Z Z =Om"i C�0�®�z N n m D m m -D--1®!:jZ r} O =�D=p-< Z=m-{r m>� D m 2 D Z n- • • m < O D m m m r) n O z D n mcmi� ® n z m m < m O W m 0 m z D m 7o C W {W w n �; -< D D D D n n n n m N fV U'i Fen t� M > vi H.1 n O� C� 7y M Z,^�wo�Cy1 t1J tJl p u '0 I z� n m x n-< m Z 0 n o Q NJ 0 m M m m * (n m o Z o ® D z T! 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