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HomeMy WebLinkAboutBP25-092PERMIT # SECTION � c TYPE OF WORK, JOB LOCATION OWNER CONTRACTOR c� EST. COST G ""elcO #' ) — TCO # DATE: RLnPR /0L / r� 14Jt4/0OC 7r✓I e i � G/iJ 2jr� of p: / LOT % LaVQ4 d -e y J/Q-/3, 3. DATE % 0 FEE DATE FOOTING FOUNDATION FRAMING -- / RGH FRAMING U� �1461 'ICI )r'G7ii1 C/PQni.� INSULATION ( PLUMBING LYJ ZZ� ZoZS /emu l RGH PLUMBINGGAS 0 SPRINKLER _ / S.SQ/7al�tJ/PLT'!C E!_ECTRIC a aS LOW -VOLT O ALARM C� AS BUILT 0 FINAL OTHER APPROVALS ARB BOT Ps ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-094 Certificate of ®ccupaucp This is to certify that �/ f of, NY,, having duly filed an application on JU /LA ` 20 a 5 requesting a Certificate of Occupancy for the premises known as, (��iY{�aG(,tL(i�0r ��/`�� , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: q-J&Block: Lot: tX and having fully complied withthe requirements of the Building Code and the Zoning Ordinance under Building Permit No.c25—0%assued 20�, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications,Use: R- 16"e— ral-�J/q Construction: for the following purposes: Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises. building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement. whether by extending on any side or by increasing in ht shall be mad , or shall the building be moved from one location to another until a permit to accomplish such change tas§een I fro -Building Inspector. Building Inspector, Village of Rye Brook: Date: JUL 2 4 2025 E C EE 'M i BUILDING DEPARTMENT For office use onI FRJUL 18 2025 PERMIT# VILLAGE OF RYE BROOK ISSUED: I VILLAGE OF RYE BROOK 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE: BUILDING DEPARTMENT (914)939-0668 FEE:I `J O-- PAIDS Ni�%v.rs ebrooknv.goN 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 asssssstarrsrrrsrrrrrr»rrrrprrrr•srrssssrsrrrrsrssssssssssssrssrrsrsrsssssssssssssssssrsssssssssssassssssssssrss rssssrrsss Address: i (L (j.v W W.w 0 Occupancy/Use: - F(Avl Parcel ID#: Owner: Vvt '�T �cShft✓'t Address: 21 P.E./R.A. or ontract Sper -' G Address: Z Person in responsible charge: '�►'� D`t W%j (kV__ Address: y o k i4t O 1(// t r)'} tJ Application is hereby made and sub witted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/constructionialteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: being duly swom,deposes and says that he/she resides at P in the County of in the State of l ,that t j 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:5 S 6 vJ for the construction or alteration of: jl�l > Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created.erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this J Sworn to\before me this ` day of , 20 Z•C- day of V�� f ,20 Z S Signature of P erty Owrter " Signature o licant Pei ?me" ` AZ�� Print NarVor Property Owner Print Name of Applicant- 41upko�_ &384 Qom, Notary Public Notary Public aluan eng Notary Public REEk-A,SAMARNEH srir-o2a rMyAppointment te of Washington Notary Ptit• c-date of New Yo,k No.01SA6155217 Expires 411912026 Qualified in Westchester County mber 22016735 J �� t.1y Commission Expires Nov.6, �c BRO If w � BUILDING DEPARTMENT [I BUILDING INSPECTOR 12A SISTANT BUILDING INSPECTOR VILLAGE OT RYE BROOK ❑CODL+ENFORCEMENT OFUICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAX (91.4) 939-5801 wwwrvebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : L- Ae Zo(J WwJ C,.ec1b DATE: �- ZZ` ZOZJ-- PERMIT# F,->T Z S0 12- ISSUEll:S- I'Zr SECT: .26 BLOCK: / LOT:7� LOCATION: _ (�/�, r' 1•�l..�Q�, 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. Le- I 4 0, L 1 t� � t g 11.� & N )oa4 IO- . ❑ L.P.Gas ❑ FUEL TANK ❑ FIRE SPRINKLER. ❑ FINAL PLUMBING ❑ CROSS CONNECTION ,20"FINAL ❑ OTHER ��y6 BR( O �m BUILDING DEPARTMENT ��❑BUILDING INSPECTOR J2' SSIsrANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENTORCEMTNT OTTICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.Lyebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: 7/ Alr ow (,good & DATE: � C PERMIT# Pf2 2,S -U 7 S ISSUED: SECT: /• L BLOCK: I LOT: 2,7 LOCATION: _ t J OCCUPANCY: ❑ Violation Noted THE WORK IS... 42 MASSED ❑ FAILED /REINSPECTION ❑ SITE INSPI?CTION REQUIRED ❑ FoOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ :RoUGII PLUMBING ❑ RoUGJI FRAMING ❑ INSULATION /� /- ❑ Natural Gas r�a tn s/ 6tr a L iZe 4e ❑ :L.P.. Gas ❑ FUEL TANK ❑ FI E SPRINKLER "INAL PLUMBING ❑ CROSS CONNECTION P FINAL ❑ OTHER 6-1 _ N O (U y tn A O � 7 4 . cn . m � F-I a pp 0 ■ -U w a 7 W m Ru z a a i0. � o A V) < a Y W "c � W cz lul "Al © w _ W x � aN O zz, wE U s UO z� A m � Y � PQ m � 0m0 � � W '"'� � �"� O � � � v u a^G �• � a z z © U � v o � a Ell 5. b «: A O p z o CL � VE ga 14 O c a� V © w H p o �° ud x _ o ogw � " H V V U z w i o y a.^ a = N A W O a� U o v xIOU _ BUILDING DEPARTMENT" VILLAGE OF RYE ` MAPR DE oOK 16 2025 D) 938 KING STREET RYE BRO '�,NY 10573 (9114)939-0668 i VILLAGE OF RYE BROOK BUILDING DEPARTIMENT fitW IV. , OV --- - _. -�� INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: APR 2 4 er d Application Fee:$ yy t�q Approval Signature: Permit Fees:$ T Disapproved: Other: ao Application dated: 7 my is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: .Z Ir &t- 0 vu ` I ✓ E`t SBL:�of// /• 9—r �7 Zone: /4U6 2. Proposed Improvement.�.I?f escribe in et/a1 - u V e t 5 t r'u (/( t�(t-c/ (At r Gc 4'r cu I- !1t " �L Le Le {.N KeW Ct� (rlte1S tavt(hl !/ Ci4 ra C L-C f L w L M l N or 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: L Yes: If yes,indicate: TIER I: TIER IL TIER Ill: 4, Will the proposed project require the installation of a new,or an extension/modification to an extsfi g automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fain.,2 fam.,comm.,etc...)Prior to Construction: (1)-6L4 e After Construction: 1 - V`~o 6. NX State Constructi n Classification: N.Y.State Use Classification: 7. Property Owner: 4 K 4 i\ t ( k A- Address: V t/d w v J C G-A Phone# Cell# {�1� 1 1l- 1 3( f email: AAa', W if ° A'L r�`K 8. Applicant: Ll� �W y ` Ad"�L Address: �- pit 9 e 0(-* YoA va"f CU Phone# I k`(' 't+P3 Cell# "l il email: Lov/r)!._(5oAo JW,iC+r 11F`f 9. Architect: Address: !/ Phone# Cell# email: 10. Engineer: Address: Phone# (ni rr Cell# email: 11. General Contractor:J�l�l - a-C' Address: P ►fY 1-�' `�'� � (�Jj Phone#10- �3 t �''�' � ` ! Cell#!! _1( Jp�_'Jl f email:UVTI.0J,16�d �KAk VAFJTft Jf�y• 12. Estimated cost of construction $ 1,wo (NOTE:The estimated cost shall include all labor,niatertal,scaf7olding,fixed equipment,professional fees„and material and labor which may be donated gratis.) 13, Job Timetable: Start: ��'lt'1`L '`""� Finish: (1) 6/1/2024 BUILD DEPARTMENT VIL An E OF RYE OOK APR 16 2025 $ 938 KING iI REET RYE BRO ,NY 1OS73 (914)939-4668 i; VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER )rr as: f�ktk � N- '1'UVJQaJ cir -e �J(� residing at, (Print name) (Address where you live) being duly sworn,deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; _�( �V'/-OW 00 C�'. , 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. 1 ' J (Signature of P erty Owner(s)) ra Ing ItIc1�Ye (Print Name of Property Owner(s)) Sworn to before me this (b day of A-PrT 52 k0l,-,_W" A ( otar� P C) §kg§W AM,RIVERA (Votary$'ok,State of New York Np,01RI8441398 Qualified in Westchester County (2) Commis4i9n l rpirpw September 26,20� 6/1/2024 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW Y RK,COUNTY OF WESTCHESTER ) as: [, LAO ,being duly sworn,deposes and states that he/she is the applicant above named, (print nam of individual signing as the applicant) and fUrt er states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the CU Al_v _ ��_ _ 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 l Sworn to before me this day of , 20 day of ( , 20'Z2� Signature of per y Owner Signature of Applicant Print am fProperty Owner Print Name of Applicant Notary PAW. Notary Public \ REEMA SAMARNEH GREGORY M.RIVERA Notary Public-State of New York Notary Public,State of New York No.01 SA6155217 No.OIR1691398 Qualified in Westchester Coun Qualified in Westchester County My Commission Expires Nov.fi Commission Expires September 26,21�5 (4) 6/l/2024 • �i'�ii�` �i�` ���i�i�i�i�i�ii�i��r�i�i'r�i�iir�l�w�' �il�i �i��r''i �` ��i �' �"�I��i �r�i`���i�l�ii ai � a e-1 z' N eq 4 N s N �t W 00 4 O ce u ul y W O ? C F. a a oo x . F+ v� K F z N � °Ocn r to ' "T U cIT W 00 oc Iv i CA ul _ N O z J Q a ` 0 O � w off cw7 o o � W7 Q� N F o = U A W z a p BUILDING UEPARTMENT D (� VI %-, 2jP YE OK 938 KIN B ,NY 10573 APR 2 4 2025DD n VILLAGE OF RYE BROOK ELECTRICAL PERMIT APPLICATION BUILDING DEPARTMENT Westchester County Mast/err Electricians License Required / FOR OFFICE USE ONLY BP#: CJ EP#: � Approval Date: M — Permit Fee: S Approval Signature: Other: *********************************** ****** ***************************************************** DO NOT START WORD or CONSTRUCTION l NTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. TIIE .ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE 1'O AL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 7,o is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an ,or r ove 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 conf rmance with all applicable Federal,State,County and Local Codes.. 1.Address: ✓✓t iN Ct /C l SBL: I ! ��—� �� Zone: 2.Property Owcer: U n "r? h4 r l c (r't Address: l ✓✓U N�� V Ct✓Vc r/(n Phone#: 1 y— Z—121(P Cell#: email: 1-1 VI4P_ 1` q t d L H uTm 14 i L d-, 3.Master Electrician/Licensed Installer: L E'�4,4—p,,ty 0 Address: _,�a 5,q j-fi «JAL' ti i-40 Lic.#:Phone#: c/i`/ -776 "ySClcell#:V iV-go` - c-, 2 email: ,`NIZ-gf'i O( j lA S All, e 0 A-1 Company NameA rSSA--P•Lf L ctl c<< Z�-t• Address: ,-11 1 ;k�I Tff CF1Nd •".U) M% 4.Proposed Electrical Work/Fixture Count: C✓f f l is ,/�!%6H4-2--' 9C C C�7Yt f C_ A L_ 5.3rd Party Electrical Inspection Agency: S L� ***********************k****k**k**************k*************k**k*****************k***k************t*kk*k* STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: / L Cis SR�h/IrJ 2�"L14 /KO,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual si nmg as the applicant) state that(s)he is the /W 5C`VC nOfor the legal owner and is duly authorized to make and file this application. (Master Flectncian/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications•as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before rn e this Sworn tolZefore me this L-� day of }� .20 r � day,of 20 SignaturgAf Property Owner " Signature of Applicant N/dm1e of Prope O er a of ppli ryVak51 RO A MtNa - [NO:TARY PUBLIC„ST J.�r No.01ME616G063 stration No. 1iORK Qualified InWestchester County �1SE6080125 alified in Orange County 6/l/2o24 Commission Expires lentlary 29.20� sion Expires September 9,20i STATE WIDE INSPECTION SERVICES, INC. ••0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# L , — / Date 14 Bldg Permit# /% 0 l s1�_ ^9 / r— t / � Sq Ft Plumbing Permit# Final Certificate# City/Village T �0�/` Zip Building Dept. County Address a/ 220 V/WC24)'q C/1- Cross Street Section Block Lot Owner Name/Address(fr different than above) O t//3 ",-/�� C �� Contact Number ❑Basement ❑1st FI. ❑2nd Fl. ❑3rd Fl.` ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation D ECIEME 3D APR 2 y 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address U KC( D( S — 1-4 Name License# /3 T.2— Date Signature Address ,t S M(jy G L v✓L� /7�//fi'r� City/State `./�hr ,,��/�� ',& I Zip Code/ �v Company cs�i rO/�J C K-7r1 i e- .2Nc Phone# �f// 7�E� �5- OC a --] ID State Wide Inspection Services 1080 Main reet CA� MAY 2 8 2025 Fi hkill, NY 12524 845 202-7224 Phone XO VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.com 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: Alessandro Electric Hongmei McIntire 221 Smith Clove Road 21 Arrowwood Circle Highland Mills, NY 10930 Rye Brook, NY 10573 Located at: 21 Arrowwood Circle, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP25-116 129.26 1 27 Certificate Number: 2025-3549 Building Permit Number: BP25-092 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: 21 Arrowwood Circle, 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 271h Day of May 2025. Name Quantity Rating Circuit Type Luminaires 06 GFCI 08 Switches 04 Receptacles 03 AFCI 05 20 Amp AFCI 01 15 Amp Surface Light Fixtures 06 A Visual Inspection of existing conditions was performed on May 27th 2025,of the First Floor Kitchen and Conforms to NFPA 70-2017 NEC. No Defects Were Noted. 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. t s LO L N = _ O O N p W = � N N � W a w O , a N � Ln o M ✓O '� �'+ In w $ O Z W z V o ° A 010 co CO �• �' � � w � c cal.' �f cx w a z �� U O (� oo �-+ Z y C ' Ln w 1 " z O c� 00 it PLO > V ono r. �' �" .., ,� LT4 � tn 5 ¢ P , p o z H o w0.0 w C w o z o < v� fy w `n U " o z H A z Q o N A w Z Q Q oA w .V. w OF w x � e�wn Q � L� QV �� BUIENT APR 2 4 2025 VILOK 938 KIN NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ov PLUMBINGG PERMITT APPLICATION FOR OFFICE USE ONLY BP PP Approval Date: MAY— 2025 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, 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(ill be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: � ✓✓y�/"�`� I SBL: ZC->91 C�6 Zone: 2.Proposed Work: t." y Cr )at Ct 5 1 r► K 01 ti h,.'j C S ti t t7 3.Property Owner: C 1✓A Address: v a%W v" C l✓L Phone#: Cell email: p� 4.Master Plumber: Q t✓ a i f U Address: ( �1 t° A✓ f�° o pL Lic.#: Ho Phone#: Cell#:�� —sC)j_1 I email: P�,Lf S d S3 C� k�fi►t^a `�J"'" Company Name: Address: ` _�l4Cu �(/t AvP (�VJ5(e1 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 l tS 2nd Floor 3`d Floor 4'h Floor 5`h Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 6/1/2024 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 b ore me this Sworn to b fore m�(this d day of t_ ,20 day of r 6` 20 Signatl, of Property Owner Signature of Applicant L e-, ' X, -7,,�' '-e V\ , Print a of Property Owner Print Name of Applicant No'ary �014 M.RNERA Notary lic LAWRENCE J. noNoquE Natary Public,State Of New York CorrWIssioner of n eds No.01Ri6441398 CitY c, Yonkers, Y. Qualified in Westchester County Commission Expires al JZq Commission Expires September 26,20& This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/1/2024 BUILDING DFPA MENT D F�� v VIL E OF RYE OOK 938 KING ET RYE BR4 ,NY 10573 APR 2 4 2025 4 939-066U w eizi ov VILLAGE OF RYE BROOK `"JILDING r r7 . '7". lENT 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: 31, ✓l yt'i � t 1 ��"C��^- , residing at, �� �t�✓�✓��� C�2 . (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; 2 �✓�w C 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 operty Owner(s)) A /)/e i ' ///C � (Print Name uAroperty Owner(s)) Sworn to before me this U day f l ,20 (Notary P ) GREGORY M.RIVERA Netary Public,State of New York No,01 RI6441398 3 Qualified in Westchester County Commission Expires September 26,2 6/1/2024 .Btuldin2 Permit lCheck List& nin al sis Address: �JIJ - C t SBL' Zone i u'nse: ` Const.Type: Other. Submittal Date: `�\ Z� Revisions Submittal Dates: Applicant: Nature of Work n� J Reviews:ZBA:APR 28 2025 PB: BOT: Other. S:W.n 500,G1 NEED OK /���� --Pr FEES:Filing: � � BP: C/O: Flood Plane: Legalization: ( ) ( �APP: Dated: Notarized: SBL: Thus 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: ( ) (v�LANS:Date Stamped. Sealed: Copies" Flectronic: 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: REQUIRED EXISTING PROPOSED NOTES APPROVED Area: _ ADD 2 8 2025 Circle: Fronts e: Front: Front: Sides: Rear. Main Cor. Accs.Cor. Ft.H Sb: Sd.H Sb: GFA: Tot.jmR: Fc I Parlun� Height/Stories: notes: W^ ` o IT i O � � t- z O �• Q cS ° ° v` ZW _ P � 0Q� Wo �, ti m 3 F m A c £ � rA > � z 0 0LD z r A 96 a 01 y 0 O m m z La LU �.,,,� c c �-• CL £ E cn W Y cow Z -_v m d p! pq z U. W 5 a lam' W Yo W O °^' gym = ,yr w m O °O w os � ' aM o w °" o � Z t� .o A A w C4 Cl) a, o N M w O W ,.. p = d 41CL, way Z J � � mw £ LL a = aV � d w 8 0a h, ►'' z o U o � M w J 3 0- � � W i p Z w v CO t ouj LLI 0,)) O v, LU E O w4 fo W Q s •o pl _+ 4D o O I � o sc p z W s H L `° n p s O a J Q LLI L o a A V 1 �• W W W w LUL. r ♦ V A O z 4 co �•f'•Yr' AAf). AAN`. /A' ^ 1 / ih A ih Ai �, - I1h\_ �.. s� ✓. ma O �ST1 a O U') v .0 n CV r.: Y C ) . > a- N C L UCN �__• C) 'mow y o ot :�� ,Li V H o � cn ��:• -�C C, .. G� �+ LLJ z U o o '� o�ection tip, CL ��• _ Q 17 LLI m W in O Q �•. Lij W Q z 3 o� G , ." 4- C7 N O y NLL. LL � bH • ' k O 04 U V7 ♦ }K � 4 ri _r 9 �,cz5: 11 11'a .:�• - ze:`11 11 • '11 N Lr 1 1 1 //11 - 1 //1 1 - - 1 //1 1 1 1/ 1 1 III 1� —t -a1 111� 1AWA FX �III/IIIIII '1111/11' 111111 y '111/111' '1111111 '1'Illlli e# 2 f�yo dl'Illljliy •�1• - A ♦♦ A ♦1� 9�A �N '+7Ar ♦If A H� iAfaS{.., . A ^ d.l '�' L] J F ^ACORO A (MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE DATE 0F4/16/2025 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 CONTNAME; Christopher Januski J W I Group PHC No (914)_968-1344 FAX 125 Corporate Blvd Ste 304 E-MAIL Arc No):(914)968-1631 chris@jwigroup.com @jwigroup.com Yonkers, NY 10701 INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A: Utica First Insurance Company 15326 INSURED INSURER B: _ SKILL CRAFT GENERAL CONTRACTING LLC INSURER C: 2 Abbey PI INSURERD: Yonkers, NY 10701-1749 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000508-241122121202 REVISION NUMBER: 6 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST ED 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 ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DDrYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY ART3000809160 11/21/2024 11/21/2025 EACH OCCURRENCE $_ 1,000 000 CLAIMS-MADI= I X]OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 2 000 000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMI $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIN3 HCLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE a (CMJ) C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CMJ on 04/16/2025 at 09:43AM NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE U An An AA 453110812 JWI GROUP, INC f 125 CORPORATE BLVD �' SUITE 304 YONKERS NY 10701 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SKILL CRAFT GENERAL CONTRACTING LLC VILLAGE OF RYE BROOK 2 ABBEY PLACE 938 KING ST YONKERS NY 10701 VILLAGE OF RYE BROO NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2455 692-0 317373 10/11/2024 TO 10/11/2025 4/16/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2455 692-0, 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:NWWW.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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 STAT SUR NCE FUND T 4/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:615544672 U-26.3 -P a O O O C1 n C) CD CD cc t y < 7J =.waemve. nr ;�aut �'uar�� �pJr1! � ➢OAp}L{ � Vy®16 � ��YIYM.1➢>:'�wTtlecTi� :]tl.f'[L:' "7 .0 R yof f F l7 t c lls..11l 0\J cm y, 1 1 :7 CD 0 90 3 CD (n cn m CD CD CL 41; co t7G w .ru 77 2'4„ 77 24 " 32" 32" 1011, W 411 00 ra 0 0 co 241